While President Obama set a goal for all Americans to have a digital health record by this year, cost and other factors indicate significant challenges ahead for the nationwide transition to electronic health records (EHRs) for health care operators, writes the Washington Post in its Health Reform Watch series.

EHRs are believed to be safer and offer access to better coordinated care. However, such systems come with a hefty price tag.

For a five-person practice, the first-year investment costs $162,000 on average, plus nearly $85,000 in maintenance fees, The Washington Post writes, citing a one study. The costs could run into the millions for hospitals.

Yet, operators are making progress, data show.

In 2008, less than 10% of hospitals had at least a basic electronic health system. In 2013, the percentage of hospitals that had at least a basic EHR jumped to 58.9%, data show. In 2013, about 25.5% of hospitals had a comprehensive EHR.

Doctors’ offices show a similar uptake of EHR systems, with about 48.3% having any type of EHR system in 2009 and 78.4% having any EHR system in 2013.

Medicare and Medicaid payment program standards are making it increasingly tough for hospitals and doctors to receive payments from those federal programs.

“It’s one thing to have patient information in digital form, but what really counts is what happens after that,” The Washington Post writes. “Just six percent of hospitals are ready for the second stage of the program this year, when they also face the risk of penalties for not meeting the program’s requirements. The [Robert Wood Johnson Foundation] found that while most hospitals can meet many requirements — such as sending online data to public health agencies and recording patient information — they’re still struggling on one key function: sharing information with patients. Just 10.4% of hospitals can do that now.”

But these functions, as well as the rate of doctors and hospitals investing in electronic records, are likely to increase as health care continues to shift to a system that is rewarding providers for better care, University of Michigan public health professor Julia Adler-Milstein tells The Washington Post.

“If you don’t have this data to know how you’re performing, it’s going to be hard to figure out how to improve value,” Adler-Milstein says.